PULSE FIRST LOOK: BANGING THE BERWICK DRUM - All Republicans on Ways and Means will release a letter today asking Chairman Levin to schedule a hearing with the new CMS administrator, Don Berwick. “Members of Congress and the American people were denied the opportunity to hear Dr. Berwick’s testimony and learn how he intends to ensure that seniors’ access to care is preserved…." Letter http://bit.ly/cyYQPo

POLL: REFORM SUPPORT DOWN - Bucking the general trend of reform inching up in popularity, a new CBS poll has 49 percent of Americans disapproving of the health overhaul, up from 47 percent in May. Thirty-six percent of the public supports the law, down from 43 percent approval in May. The figures are still better for Democrats now than they were in March when the law was signed. At that time, 53 percent of the public disapproved and 32 percent approved, according to the CBS polls, conducted from July 9-12. http://bit.ly/9apYuE

By Sarah Kliff and Jennifer Haberkorn

Good Wednesday morning. “I hate to break it to you babe, but I’m not Pulse.”

MEANINGFUL BACKLASH - Lots of react on the Meaningful Use Regs for electronic medical records out yesterday. Hospitals say the changes don’t do enough to make the requirements of the electronic health records program, including its financial incentives, realistically achievable. “Unfortunately, CMS continues to place some barriers in the way of achieving widespread IT adoption by our nation’s hospitals and physicians,” says AHA president Rich Umbdenstock, who praised a handful of other changes. AAMC agrees. Other groups, including the Federation of American Hospitals, endorsed the new reg. AHA is trying to figure out how to move forward – possibly through pushing for legislation – to address the “multi-campus disparity,” which would penalize all the hospitals in a system even if only one doesn’t comply in later years, they say.

David Blumenthal, national coordinator for Health IT at HHS, said the agency tried to respond to the 2,000 comments on the reg, many of which said the rule was too inflexible and took an “all or nothing” approach.

Ways and Means Health Subcommittee chair Pete Stark has already scheduled a hearing on the meaningful use rule for next Tuesday. Witnesses TBD. http://bit.ly/bAyiGc

“LIKE 495 AT RUSH HOUR” - Don May, AHA’s vice president for policy, says the quick timeline in the regs could impose too much of a burden on the infrastructure to set up the EHRs. “Everyone is going to vendors at the same time. Even if [the hospital] is ready today, they may have to wait 18 months before the vendor goes out to implement it,” he tells Pulse. “What we’ve created is this market that’s going to be like 495 at rush hour….And that’s our concern.”

NEW MAN AT PhRMA - POLITICO’s Chris Frates with more on new PhRMA head John Castellani: “Castellani comes to PhRMA well-positioned for Washington in 2010, as something of a hedge depending on what happens in the November midterms — on good terms with the Obama White House, but also set up nicely in case Republicans take over the House of Representatives.” http://politi.co/aXqLJB

NEXT UP - FLOTUS and SLOTUS join Sebelius headlining today’s roll out of preventive care guidelines. Expect today’s announcement to outline nuts and bolts of regulation and implementation. The launch event – today at 2:15 pm, live from George Washington Hospital – marks Michelle Obama’s first health reform event post-passage, although the First Lady has worked on other health-specific initiatives.

NOT A DONE DEAL - USPSTF guidelines do not regulate which services the Women’s Health Amendment will cover; reproductive rights groups expect some guidance in this area today, possibly in the form of a timeline, but no definitive list. Their lobbying efforts, to ensure that certain medications and treatments get included continues full force: 300 Planned Parenthood advocates fan out across the Hill this week to push their representatives to categorize birth control as preventive medicine.

PULSE POLITICS:

BARBER OUT - The Alabama Tea Party candidate who became synonymous with his ads instructing Americans to “gather your armies” and comparing health reform to “slavery,” Rick Barber fell to Montgomery City Councilwoman Martha Roby in yesterday's GOP runoff for Congress in Alabama's 2nd district. http://bit.ly/c24nAK

FROM THE BUREAU OF SUMMER 2009 - Explaining his support for health reform over recess last week, Texas Democrat Ciro Rodriguez had an outburst reminiscent of last summer’s town hall tussles. In video, now being circulated in conservative circles, now up on Andrew Breitbart’s YouTube station, Rodriguez shoots back at a constituent who questions his use of CBO numbers: “Ma’am, don’t accuse me of not saying the truth.” Rodriguez, who blames the incident on his Republican challenger Francisco “Quico” Canseco, apologized to a local paper late Tuesday. Videohttp://bit.ly/bHy439

STUPAK CUTS CHECKS FOR ANTI-ABORTION DEMS - From the 2010 desk, POLITICO’s Alex Isenstandt: “Retiring Michigan Rep. Bart Stupak is showing his gratitude to fellow anti-abortion Democrats with a wave of farewell contributions, offering financial support to several colleagues who helped him in his high-profile push for restrictions on abortion funding in the health care bill." http://politi.co/b4ypRa

THE HEALTH CARE SHUFFLE - Liz Fowler, who was the Finance Committee’s top health policy advisor, moves to OCIIO to serve as deputy director. David Schwartz, who has worked on the committee since 2004, will be promoted to Fowler’s old post as acting chief health and welfare counsel.

HHS RESPONDS TO GOP - Sebelius told Senate Republicans that their critiques of the recent CMS brochure, which outlined reform-related changes to Medicare, are off base. In a letter to Sen. Grassley, Sebelius said the mailing was “completely appropriate” and she disputed several of the statements Republicans said were inaccurate. Republican staff countered with a brochure of their own, which aims to challenge pieces of the CMS brochure, including cost savings, Medicare Advantage and choice of doctors. Sebelius letterhttp://bit.ly/a7XluFGOP responsehttp://politi.co/cNIfOp

$18.9 MILLION - HHS spent to create and mail the brochure, with suggestions from the White House, Sebelius said in the letter. But CMS was “ultimately responsible” for what was printed and how.

$95 MILLION - Amount allocated in a small tax extenders House bill, expected to hit the floor today, for CMS to reprocess claims reimbursed at lower rates because of the delayed doc fix. Bill summaryhttp://politi.co/cKUYtI

HAPPENING TODAY - The House Education & Labor Committee is marking up the Improving Nutrition for America’s Children Act. The reauthorization, which includes new funding for an expanded school lunch program, is expected to pass out of committee easily.

FUNDING MATCH-UP: TEACHERS V. BIO-TERRORISM EXPERTS - The government's Project BioShield has delivered 1 million doses of its first in-house vaccine, for smallpox, to the Strategic National Stockpile (it began shipping the medication back in May). The development is notable now, in that it’s about a week after the House Democrats’ appropriation bill called for $2 billion to be moved away from the anti-bioterrorism research project, to provide funding to prevent teacher layoffs. Former Homeland Security chief medical officer, Jeff Runge: “I don't think anybody who understands the urgency of bio-preparedness is happy with where we are right now.” http://bit.ly/cVLrNW

WHAT WE’RE READING:

HEALTH INSURER EARNINGS UNCERTAIN - Dow Jones Newswire’s curtain raiser on what to watch as major health insurers report their earnings this summer: “While the federal overhaul of the health-care system could add millions of new members to companies' rolls, it also places new taxes and restrictions on the industry." http://bit.ly/bTKS73

NEW ALZHEIMER DEFINITION LOOMS - NYT’s Gina Kolata on A1: “For the first time in 25 years, medical experts are proposing a major change in the criteria for Alzheimer’s disease, part of a new movement to diagnose and, eventually, treat the disease earlier." http://nyti.ms/cQ6wJj